MEDICARE: DR. PETER BOHDAN BANDERA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	MD041244L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316965643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER BOHDAN BANDERA M.D.

Provider Business Mailing Address
First Line	:	1 E BEACON LIGHT LN
Second Line	:
City	:	CHESTER
State	:	PA
Zip	:	19013-4433
Country	:	US
Telephone Number	:	610-532-2633
Fax Number	:	610-532-7856

Provider Business Practice Location Address
First Line	:	217 KEDRON AVE
Second Line	:
City	:	FOLSOM
State	:	PA
Zip	:	19033-1310
Country	:	US
Telephone Number	:	610-532-2633
Fax Number	:	610-532-7856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	11/14/2017

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